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Open Access Research article

Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

SD Jayaratne1, Vajini Atukorale2, Laksiri Gomes2, Thashi Chang3, Tharindu Wijesinghe2, Sachie Fernando3, Graham S Ogg4 and Gathsaurie Neelika Malavige24*

Author Affiliations

1 Department of Medicine, University of Sri Jayawardanapura, Nugegoda, Sri Lanka

2 Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayawardanapura, Nugeguda, Sri Lanka

3 Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

4 MRC Human Immunology unit, Weatherall Institute of Molecular Medicine, Oxford

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BMC Research Notes 2012, 5:645  doi:10.1186/1756-0500-5-645

Published: 20 November 2012



The WHO guidelines were revised recently to identify patients with severe dengue (SD) early. We proceeded to determine the usefulness of the warning signs in the new WHO guidelines in predicting SD and we have also attempted to define other simple laboratory parameters that could be useful in predicting SD.


Clinical and laboratory parameters were recorded in 184 patients in 2011, with confirmed dengue viral infections, admitted to a medical ward in two tertiary care hospitals in Colombo, Sri Lanka.


We found that the presence of 5 or more dengue warning signs were significantly (p = 0.02) associated with the development of SD (odds ratio 5.14, 95% CI = 1.312 to 20.16). The AST levels were significantly higher (p = 0.0001) in patients with abdominal pain (mean 243.5, SD ± 200.7), when compared to those who did not have abdominal pain (mean 148.5, SD ± 218.6). Lymphocyte counts <1,500 cells/mm3 were significantly (p = 0.005) associated with SD (odds ratio 3.367, 95% CI 1.396 to 8.123). High AST levels were also significantly associated (p < 0.0001) with SD (odds ratio 27.26, 95% CI 1.632 to 455.2). Platelet counts <20,000cells/mm3, were again significantly associated (p < 0.001) with severe disease (odds ratio 1.632 to 455.2, 95% CI 3.089 to 14.71). The PCR was positive in 26/84 of the patients and we found that the infecting serotype was DEN-1 in all 26 patients.


The presence of 5 or more warning signs appears to be a predictor of SD. Lymphocyte counts <1,500 cells/mm3, platelet counts <20,000/mm3 and raised AST levels were associated with SD and could be used to help identify patients who are likely to develop SD.

Dengue virus infection; Shock; Warning signs; WHO guidelines; Laboratory parameters; Clinical features